GP sought to establish first practice on island. No electricity. No telephone. Nearest hospital 12 hours away by boat, weather permitting. Obstetric skills and Gaelic essential.
That, in essence, was what The Highlands and Islands Medical Service was offering. Plus a house, a rowing boat and car (of limited use as there were few roads), and a basic income so that the doctor could afford to treat those who couldn’t give even a chicken in payment.
Dr Alexander Macleod took up the post in the Outer Hebrides in 1932. He was responsible for 3000 people on North Uist and 16 outer islands, some home to as few as two families. He’d spent a year in Antarctica, then worked as a locum in cities and country. As we know, locumming teaches you flexibility and independence. But he didn’t find his new job easy. He later admitted that at first moving to North Uist felt like a big mistake. He was always finding fault. Then he realised that it was he that was out of tune with island life, and he settled down.
Islanders’ health was very poor. Isolated from the rest of the world, they relied on each other and superstition. TB and measles were rife. So was diphtheria: one family had lost four children in three weeks. Public health was non-existent. So there was much to do. And he did it. A patient called him ‘a one-man walking hospital’.
An Dotair Mòr – the big doctor, as he was known – was always available. He was a witness to his patients’ lives and their sufferings. He understood that medical and social needs are inseparable. He knew when to look for the real reason for a consultation; patients’ body language, he said, was “straws which show which way the wind is blowing”.
He never refused a visit. Emergency requests were delivered by a messenger or in Morse code via the single wire which ringed North Uist. He would travel by car, boat, horse, tractor, and on foot. A lantern or a white sheet would signal that a tractor should come and pick him up. Once he had to swim for it when the boat foundered.
In 1932, patients who needed urgent hospital care faced a long, uncomfortable journey by sea to Glasgow. Dr Alex persuaded the Daily Record to sponsor a mercy flight and in 1933 a biplane first landed on the beach. The air ambulance service is one of his many legacies. It didn’t just take ill patients to hospital; it brought back the dying to spend their last days at home.
He delivered 2000 babies, including John Gillies, future chair of the Scottish RCGP, and the techniques he devised for managing obstetric emergencies unaided were published in the BMJ and widely adopted. When childhood immunisation was introduced in 1955 he tested it on his own children before persuading the islanders to accept it.
He served North Uist for 40 years. His wife, Dr Julia, was also a GP. She ran the practice, milked the cows and stood in when her husband was out visiting a patient or away challenging authority at meetings. One January night in 1935 she went to help a nurse with a difficult delivery. The visit involved a 45 minute boat trip and a two mile walk there and then back again after the successful delivery. Two days later she herself gave birth to the first of their five children.
When Dr Alex retired, aged 80, his son Dr John and daughter-in-law nurse Lorna carried on the tradition of service to the community. Dr John held educational meetings with local fisherman and emergency services, and secured legislation for sailors to wear lifejackets when he realised that several fisherman had fallen overboard and drowned when they took a pee over the side. Like his father, he fostered contact with the wider world and in 1998 hosted a meeting of WONCA (World Organisation of Family Doctors) on the tiny island of Berneray.
Were the Macleods the doctors of the past or of the future? Dr Alex was independent in a way that is impossible today. He could be autocratic, but he had to think for himself. He challenged accepted dogma, but he didn’t much like being challenged himself, though he worked closely with the district nurses and a nurse who questioned him found a box of chocolates handed round the door next morning. He could be imperious. Driving around the island’s single-track roads he would never pull in to a passing place; that was for others to do. Crusty and gruff he could be, but he knew the meaning of service and he was beloved by his patients, respected by all, and a role model for the medical students and young doctors he encouraged to spend time in his practice. His memory is still very much alive on Uist and he must be a hard act for his 21st century successors to follow.
These days you are never far from a caffe latte in the Outer Hebrides, and the mobile cinema brings blockbusters to isolated communities. As long as the power supply is working. But the islands still find it hard to recruit and keep GPs. The winters are long, the wind blows year around and the population has halved since 1932 .
Even in summer the Outer Hebrides feel like another country. In North Uist in August the post-bus picked us up at the end of a walk. The postman hadn’t finished his deliveries, and warned that the 15 mile journey might take a couple of hours. We stopped to deliver a letter addressed to ‘The Nurse’s House’. It was where the nurse had lived in Dr Alex’s time. We drove down rough lanes to outlying crofts. The postman parked the van on the grass and riffled through the box of mail at our feet – bills, Amazon deliveries, Private Eye. Householders emerged for a chat, usually in Gaelic, before we drove on to the next croft. On the winding coastline near Clachan, facing the Atlantic Ocean, we came to a striking stone memorial. Erected by their patients, It commemorates the Macleods with the inscription ‘Choimhlion iad an dleasdanas gu buileach ‘ – ‘They excelled in their duties’.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…